JP2004351090A - Closure device for puncture and incision etc - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a revolutionary closure device for a puncture and an incision, etc. exhibiting an unconventional working effect. <P>SOLUTION: The closure device is for closing an opening 2 of a puncture or an incision formed on an internal wall surface 1a of a digestive organ such as the stomach, the small intestine or the large intestine. The closure device consists of a first fastening member 4A fastened to one opening edge 2a of the opening 2, a second fastening member 4B fastened to the other opening edge 2b, and an installed member 3 installed between the first fastening member 4A and the second fastening member 4B. The first fastening member 4A, the second fastening member 4B and the installed member 3 are structured so that the opening edges 2a and 2b of the opening 2 are moved to approach each other as the installed member is drawn. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a closure device such as a perforation or an incision.
[0002]
Problems to be solved by the prior art and the invention
In recent years, endoscopic treatment for excision of a polyp 5 (tumor) protruding from the inner wall surface 1a of the digestive organ 1 such as the stomach, small intestine, or large intestine using the endoscope 8 has been actively performed.
[0003]
This endoscopic treatment is to derive the polyp treatment tool 10 from the treatment tool lead-out hole 8b (forceps hole) of the endoscope 8 (video scope) in which the CCD camera 8c is built in the hose-like body 8a having a plurality of inner holes. This treatment method removes the polyp 5 from the distal end opening of the tube 10a which is inserted and disposed in the treatment instrument lead-out hole 8b of the endoscope 8 as shown in FIG. The wire 10b has a structure in which an annular wire 10b (snare) protrudes. The diameter of the wire 10b can be changed by operating a proximal operation unit (not shown), and a high frequency is generated. It is configured.
[0004]
Removal of the polyp 5 using the endoscope 8 and the polyp removing tool 10 is performed as follows.
[0005]
After inserting the endoscope 8 with the polyp removing tool 10 set through the mouth (or anus) and confirming the position of the polyp 5 with the CCD camera 8c, the wire 10b is hooked on the polyp 5 to reduce the diameter of the wire 10b. At the same time, the base of the polyp 5 is burned off by generating a high frequency.
[0006]
Therefore, if the endoscope 8 and the polyp removing device 10 are used, a large-scale operation such as laparotomy is not required, so that a burden (a physical burden, an economic burden, etc.) given to the patient can be reduced. In addition, this endoscopic treatment has received a great deal of attention as an early treatment for cancer.
[0007]
By the way, in this polyp removal treatment, the perforation 2 is unavoidably formed on the inner wall 1a of the digestive apparatus 1 because the polyp 5 is completely removed to the boundary with the inner wall 1a of the digestive apparatus 1 (the root portion of the polyp 5). There are cases where it can be done.
[0008]
Naturally, the perforation 2 must be forcibly closed (for example, if the perforation 2 is formed in the large intestine, stool may flow out of the perforation 2 and cause peritonitis). Also, there has been proposed a perforation closing device 4 (commonly called a clip) for closing the perforation 2.
[0009]
The clip 4 is made of a suitable metal, and includes a holding body 4a having a tip end portion that can be freely opened and closed, and a slide cylinder 4b fitted on the base end side of the holding body 4a. When the body 4a is slid and introduced into the slide cylinder 4b, the holding body 4a is closed.
[0010]
Therefore, the clip arrangement tool 7 inserted and arranged in the treatment instrument outlet hole 8b of the endoscope 8 described above is used, and the clips 4 are used to move the opposed opening edges 2a, 2b of the perforation 2 toward each other. , The closed state of the perforation 2 is maintained. Note that the clip 4 fixed to the inner wall surface 1a of the digestive organ 1 comes off spontaneously in about one week to three months, and is discharged out of the body together with the stool.
[0011]
However, the clip 4 is effective when the perforation 2 is small, but there are cases where the clip 4 cannot be used because the perforation 2 is too large. Must.
[0012]
However, if the laparotomy was performed in such a case, the advantage of removing the polyp 5 using the endoscope 8 and the polyp removing tool 10 described above would be lost, and of course, the polyp 5 was discovered. The treatment for removing the polyp 5 by inserting the endoscope 8 from the mouth and the treatment for closing the perforation 2 are medical treatments, whereas the open abdominal suture is a surgical treatment. There are problems such as having to move.
[0013]
The present applicant has paid attention to the above-mentioned problems, and has invented an unprecedented revolutionary closure device such as a perforation or incision that can be treated in internal medicine.
[0014]
[Means for Solving the Problems]
The gist of the present invention will be described with reference to the accompanying drawings.
[0015]
A closing device for closing an opening 2 such as a perforation or an incision formed in the inner wall surface 1a of the digestive organ 1 such as the stomach, the small intestine or the large intestine, which is fixed to one opening edge 2a of the opening 2. 1A, a second fastening member 4B fastened to the other opening edge 2b, and a bridge installed between the first fastening member 4A and the second fastening member 4B. The first fastening member 4 </ b> A, the second fastening member 4 </ b> B, and the bridging member 3 are connected to each other by pulling the bridging member 3 so that the opening edges 2 a and 2 b of the opening 2 are connected to each other. The present invention relates to an obstruction device such as a perforation or an incision, which is configured to move close to each other.
[0016]
Further, in the closure device such as a perforation or an incision wound according to claim 1, the first fastening member 4A and the second fastening member 4B are each plural, and the second fastening member is attached to the first fastening member 4A. The member 4B relates to an obstruction device such as a perforation or an incision wound, which is fixed at an opposing position or a shifted position not opposing.
[0017]
Further, in the closing device such as a perforation or an incision wound according to any one of claims 1 and 2, the bridging member 3 is a single wire 3, and the wire 3 is a first fastening member at a start point position. 4A or the second fastening member 4B, which is inserted into the remaining first fastening member 4A and the second fastening member 4B so as to be capable of being pulled and pulled. It is related.
[0018]
Further, in the closing device such as a perforation or an incision according to any one of claims 1 to 3, the proximity of the opening edges 2a and 2b, which have approached by pulling the erection member 3, is maintained. The present invention relates to a closure device such as a perforation or an incision, wherein a holding portion 6 is provided on the erection member 3.
[0019]
Further, an endoscope 8 having a treatment tool outlet hole 8b and an opening 2 such as a puncture or an incision wound on the inner wall surface 1a of the digestive organ 1 such as the stomach, small intestine or large intestine which are led out of the treatment instrument outlet hole 8b. And a plurality of clips 4 fixed to the opening edges 2a and 2b of the first and second clips. One of the plurality of clips 4 is a clip 4 to which a wire 3 is fixed, and the remaining clips 4 are inserted through the wire 3. The present invention relates to a closure device such as a perforation or an incision wound, which is a clip 4 provided with an insertion portion 4c to be inserted.
[0020]
Further, in the closing device such as a perforation or an incision wound according to claim 5, the wire member 3 is provided with a throttle member 6, and the throttle member 6 is inserted into the wire member 3 so as to slide with respect to the wire member 3. The present invention relates to a closure device such as a perforation or an incision, which is characterized by being constituted.
[0021]
Function and effect of the present invention
The present invention uses the endoscope 8, for example, to fasten the first fastening member 4A to one opening edge 2a of the opening 2 such as a perforation or an incision, and to attach the first fastening member 4A to the other opening edge 2b. By fastening the second fastening member 4B and pulling the erection member 3 installed between the first fastening member 4A and the second fastening member 4B, the opening edges 2a and 2b of the opening 2 are connected to each other. Are moved close to each other, and the opening 2 is closed.
[0022]
Therefore, even when the opening 2 such as a perforation or an incision formed in the inner wall surface 1a of the digestive organ 1 such as the stomach, small intestine or large intestine is large and cannot be handled by the above-described clip 4, the abdomen is opened and sutured. It is not necessary to perform the procedure, and the opening 2 such as a puncture or an incision can be easily and quickly closed, and the opening 2 can be treated only by internal medicine. It is possible to reduce the burden on the patient as much as possible without having to move to surgery.
[0023]
As described above, the present invention exhibits an unprecedented epoch-making action and effect, and has extremely high commercial value.
[0024]
BEST MODE FOR CARRYING OUT THE INVENTION
The drawings illustrate one embodiment of the present invention and will be described below.
[0025]
This embodiment is a closing device for closing an opening 2 such as a perforation or an incision made in the inner wall surface 1a of the digestive organ 1 such as the stomach, the small intestine, or the large intestine. A plurality of first fastening members 4A fastened to the portion 2a using the endoscope 8, and a plurality of second fastenings fastened to the other opening edge 2b using the endoscope 8. It is composed of a member 4B and one bridging member 3 bridging between the first fastening member 4A and the second fastening member 4B.
[0026]
The endoscope 8 used in the present embodiment is provided with a treatment tool led out to a hose-like body 8a having a plurality of inner holes provided with an operation portion 8f at a base end as shown in FIGS. An endoscope 8 (videoscope) having a well-known structure provided with a hole 8b (forceps hole), a CCD camera 8c, a suction nozzle 8d, a light 8e, and a treatment instrument introduction hole 8g.
[0027]
Hereinafter, each component of the present embodiment will be described in detail.
[0028]
The first fastening member 4A and the second fastening member 4B have the same structure as the clip 4 described above, that is, as shown in FIGS. A metal holding body 4a is provided at the distal end of the holding body 4a. The metal holding body 4a includes a pair of holding halves 4a 'and 4a "which can be opened and closed. When the holding body 4a is slid and introduced into the slide cylinder 4b, the tip of the holding body 4a is closed.
[0029]
Further, as shown in FIG. 4, the first fastening member 4A and the second fastening member 4B have the base ends of the holding members 4a inserted into the locking holes 12a of the connecting member 12, Is provided on a clip arrangement tool 7 described later.
[0030]
The connecting member 12 slides the holding member 4a by being pulled by the clip arranging device 7. When the connecting member 12 is pulled, the holding member 4a is introduced into the slide cylinder 4b, and is moved to a predetermined position. When the connecting member 12 is further strongly pulled in a state where the connecting member 12 is introduced to the position, the locking peripheral edge of the locking hole 12a is cut off, the locked state is released, and the first fastening member 4A and the The second fastening member 4B will be separated.
[0031]
Further, the first fastening member 4A and the second fastening member 4B are subjected to the fastening operation via the clip disposing tool 7 which is inserted and disposed in the treatment tool outlet hole 8b of the endoscope 8 described above. .
[0032]
As shown in FIGS. 2 to 4, the clip disposition device 7 is provided with a tube body 7a and a slide elongate body 7c which is slidably disposed in the tube body 7a and which is slidably moved by operating a handle 7b. It is composed of
[0033]
A clip holding portion 9 is provided at the tip of the elongated slide body 7c. The clip holding portion 9 has a first fastening member 4A and a second fastening member as shown in FIGS. It is configured so that it can be fitted and connected to the connecting member 12 of the member 4B.
[0034]
Further, among the plurality of first fastening members 4A, the wire 3 is fixed to one first fastening member 4A.
[0035]
The wire 3 is connected to the left and right clamping halves 4 a ′ and 4 a ″ of the other first and second fastening members 4 A and 4 B fastened to the opposite opening edges 2 a and 2 b of the opening 2. The first fixing member 4A and the second fixing member 4B are provided so as to extend between the first fixing member 4A and the second fixing member 4B.
[0036]
The wire 3 is a medical suture generally used in surgery. The wire 3 is preferably made of a material that maintains its shape as a thread in the body for a certain period of time in the body and has little influence on the human body, such as a material that can be naturally melted.
[0037]
The wire 3 is provided with a throttle member 6 for fixing the yarn, and the throttle member 6 is provided slidably with respect to the wire 3.
[0038]
As shown in FIG. 3, the aperture member 6 is formed of a suitable resin member and is formed in a spherical shape, and a through hole 6a for fitting to the wire 3 is formed at the center thereof. In this configuration, the wire 3 is inserted into the hole 6a. Further, the diaphragm member 6 is configured such that a predetermined frictional resistance is generated when the diaphragm member 6 is slid with respect to the wire 3.
[0039]
A method of closing the perforation 2 formed on the inner wall surface 1a of the digestive organ 1 using the apparatus having the above configuration (perforation closing treatment) will be described.
[0040]
First, one first fastening member 4A to which the wire 3 is connected is set on the clip disposing tool 7 which is inserted and disposed in the treatment tool deriving hole 8b of the endoscope 8, and the endoscope 8 is opened from the mouth. After the insertion, the position of the perforation 2 is confirmed by the CCD camera 8c, and the first fastening member 4A with the wire 3 (the first fastening member 4A at the start point) is opened at one opening edge 2a (substantially the end). (See FIG. 6).
[0041]
Subsequently, the endoscope 8 is pulled out, another first fastening member 4A is set to the clip disposing device 7, the endoscope 8 is inserted from the mouth, and the position of the perforation 2 is confirmed by the CCD camera 8c. Another first fastening member 4A is fastened to one opening edge 2a of the perforation 2 so that the wire 3 is straddled by the insertion portion 4c.
[0042]
Subsequently, the endoscope 8 is pulled out, the second fastening member 4B is set on the clip disposing device 7, the endoscope 8 is inserted from the mouth, and the position of the perforation 2 is confirmed with the CCD camera 8c. The second fastening member 4B is fastened to the other opening edge 2b of the perforation 2 by straddling the second fastening member 4B through the insertion portion 4c (see FIG. 7).
[0043]
In this manner, the first fastening member 4A and the second fastening member 4B are sequentially set in the length direction of the perforation 2 and alternately (zigzag) to the opposing positions where the opposing opening edges 2a and 2b do not coincide. Fasten via a gap (see FIG. 8).
[0044]
Subsequently, when the wire 3 is pulled while pressing the diaphragm member 6 with the pushing tubes 13A and 13B, the opening edges 2a and 2b of the perforations 2 move closer to each other (FIG. 9 shows a thick pushing tube 13A separately from the endoscope 8). FIG. 10 shows a case in which a thin pushing tube 13B that can be inserted through the treatment tool outlet hole 8b of the endoscope 8 is used, and FIG. This is the case where the wire member 3 is squeezed by guiding the squeezing member 6 using the forceps 13C having a small hole through which the wire 3 passes.)
[0045]
Since the aperture member 6 has a predetermined frictional resistance to the wire 3, even if the pushing tubes 13A and 13B are pulled out, the aperture member 6 does not slide backward, and the proximity of the opposed opening edges 2a and 2b is close to each other. State is maintained.
[0046]
Thereafter, the wire 3 is appropriately cut to complete the perforation obstruction treatment.
[0047]
Since the present embodiment is configured as described above, even if the perforation 2 formed in the inner wall surface 1a of the digestive organ 1 such as the stomach, small intestine or large intestine is large and cannot be handled by the above-described clip 4, the abdomen is opened. It is not necessary to perform a sewing operation, and the perforation 2 can be closed easily and quickly, and the perforation 2 can be treated only by internal medicine. The advantage of the endoscopic treatment using the endoscope 8 and the polyp removing tool 10 described above can be maximized, for example, the burden on the patient can be reduced as much as possible without the need to perform. .
[0048]
Further, in the present embodiment, the aperture member 2 that holds the opening edges 2a and 2b approached by pulling the wire 3 by fixing the wire 3 is provided on the wire 3, so that the perforation 2 is closed ( Until complete healing), the proximity of the opening edges 2a and 2b can be reliably maintained.
[0049]
It should be noted that the present invention is not limited to the present embodiment, and a specific configuration of each component can be appropriately designed.
[Brief description of the drawings]
FIG. 1 is an explanatory diagram of an operation for removing a polyp.
FIG. 2 is a perspective view showing the embodiment.
FIG. 3 is a perspective view showing a main part according to the embodiment.
FIG. 4 is a schematic operation explanatory view of a main part according to the embodiment.
FIG. 5 is a schematic operation explanatory view of a main part according to the embodiment.
FIG. 6 is an explanatory diagram of a use state of the present embodiment.
FIG. 7 is an explanatory diagram of a use state of the present embodiment.
FIG. 8 is an explanatory diagram of a use state of the present embodiment.
FIG. 9 is an explanatory diagram of a use state of the present embodiment.
FIG. 10 is an explanatory diagram of a use state of the present embodiment.
FIG. 11 is an explanatory diagram of a use state of the present embodiment.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Digestive organ 1a Inner wall surface 2 Opening 2a Opening edge 2b Opening edge 3 Bridge member / wire 4 Clip 4A First fastening member 4B Second fastening member 4c Inserting part 6 Holding part / diaphragm member 8 Endoscope 8b Treatment tool outlet hole

Claims (6)

A closure device for closing an opening such as a perforation or an incision formed in the inner wall of a digestive organ such as the stomach, small intestine or large intestine, wherein the first stopper is fixed to one opening edge of the opening The first fastening member comprises a fastening member, a second fastening member fastened to the other opening edge, and a bridging member spanned between the first fastening member and the second fastening member. The member, the second fastening member, and the bridging member are characterized in that the opening edges of the openings are configured to move closer to each other by pulling the bridging member. Closing device. The closure device according to claim 1, wherein the first fastening member and the second fastening member are plural, and the second fastening member faces the first fastening member. A closure device such as a perforation or an incision, which is fixed to a position or a displaced position that does not face the position. The closure device such as a perforation or incision wound according to any one of claims 1 and 2, wherein the erection member is a single wire, and the wire is a first fastening member or a second fastening at a start point. A closure device such as a perforation or an incision, which is fixed to a member and is inserted through the remaining first and second fastening members so as to be able to be pulled. The closure device according to any one of claims 1 to 3, wherein the holding member holds a proximity state between the opening edges that have moved closer by pulling the installation member. A closure device such as a perforation or an incision wound provided on a subject. An endoscope having a treatment instrument lead-out hole, and is secured to the opening edge of an opening such as a perforation or an incision wound on the inner wall of a digestive organ such as the stomach, small intestine, or large intestine, which is led out of the treatment instrument lead-out hole. A plurality of clips, one of the plurality of clips is a clip to which a wire is fixed, and the other clip is a clip provided with an insertion portion through which the wire is inserted. Closure devices such as perforations and incisions. 6. The closure device according to claim 5, wherein a squeezing member is provided on the wire, and the squeezing member is configured so that the wire is inserted and slides with respect to the wire. Occlusion device such as perforation or incision.

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